The use of likelihood ratio methodology to find predictors of treatment outcome in patients with dental injury diagnoses.

The purpose of this prospective, cohort study of patients with dental injuries was to develop prediction rules to predict treatment response related to the management of dental injuries. The study comprised of 130 patients with a single permanent incisor affected by a dental displacement (n = 100) or fracture injury (n = 30). Laser Doppler flowmetry (LDF) measurements of pulpal blood flow (PBF) were taken 6 and 18 weeks after dental injury Treatment response (success or failure) was categorized based on findings of clinical and radiographical evaluation after 9 months. Forty-four (34%) subjects were categorized as treatment success (absence of loss of sensitivity, periapical radiolucency and grey discolouration of crown), 43 (33%) as treatment failures (loss of sensitivity, and periapical radiolucency and/or grey discolouration of crown) and 43 (33%) as acceptable outcome (loss of sensitivity). After using univariate analysis to determine the association between potential clinical and LDF predictor variables and treatment response status, preliminary prediction rules were developed for prediction of success [positive likelihood ratio (LR), 29.0; 95% confidence interval (CI), 1.7-496.4] and failure (negative LR, 0.55; CI, 0.4-0.7). The most important variables were subluxation, root fracture, baseline PBF level and change in PBF level at 3-month follow-up. Outcome following the management of dental injuries may be predicted from variables collected from LDF and physical examination. Predictive modelling may provide clinicians with the opportunity to identify 'at-risk' patients early and initiate specific treatment approaches.

Targeting human immunodeficiency virus type 1 with antibodies derived from patients with connective tissue disease.

During the budding process, human immunodeficiency virus (HIV) acquires several cellular proteins from the host. Thus, antibodies against self antigens found in sera patients with autoimmune disorders may cross react with host-derived or the HIV-specific proteins gp120 and gp41 on the viral envelope and probably neutralize HIV infection. To verify this hypothesis, 88 sera from HIV negative patients suffering from systemic lupus erythematosus (SLE) and other autoimmune disorders were analysed for cross reacting antibodies against HIV-1 by Western blot and FACS analysis indicating that antibodies cross-react with epitopes expressed on HIV infected or non-infected cells. Virus capture assays revealed that HIV-1(IIIB) was directly recognized by 60% of sera from patients with autoimmune disorders. Sera were also tested in HIV neutralization assays with stimulated T cells. Reduction of the viral load by patient sera correlated with their reactivity in Western blot analysis. Complement further enhanced the reduction of viral titres, although no complement-mediated lysis was observed. These data suggest a possible protective role of auto-antibodies against HIV infection in lupus patients.

Cephalic zoster with laryngeal paralysis.

Herpes zoster reactivaction in the head and neck region is often associated with multiple cranial neuropathies, the most common one being facial paralysis. Laryngeal paralysis has also been occasionally reported with zoster infection. We present two such cases, and discuss the relevant literature on the pathophysiology, evaluation and management of this disease. Recent advances in antiviral therapy have allowed for specific medical treatment, thus making it all the more imperative to suspect zoster, even in clinically atypical cases. We suggest aggressive treatment with intravenous acyclovir for cephalic zoster complicated by vocal cord paralysis.

Recurrent infiltrating lipoma of the head and neck. Case report and literature review.

Lipomatous tumors with intramuscular infiltration are uncommon in the head and neck. Oral lipomas have been recorded in the literature; however, infiltration and recurrence have rarely been documented. We describe a case of an oral lipoma that did not have microscopic characteristics of malignancy, lipoblastomatosis, or atypia, but which showed intramuscular invasion and recurred twice after surgery. Although certain characteristics distinguish our case from congenital lipomatosis, the clinical picture is quite similar. Lipomas with intramuscular invasion uniformly tend to recur when they are not widely resected, whether in the trunk and extremities or in the head and neck. These lesions can rapidly enlarge and infiltrate local tissues, and they require wide resection with an attempt at preservation of important structures. Preoperatively, computed tomographic analysis allows a lipoma to be diagnosed by its low attenuation, and a grossly infiltrating tumor can be distinguished from the ordinary well-encapsulated lesion.

Rare presentations of ordinary lipomas of the head and neck: a review.

The ordinary lipoma is the most common neoplasm of mesenchymal origin. Only 13% of them arise in the head and neck region and most of these occur subcutaneously in the posterior neck. Rarely, they can develop in the anterior neck, infratemporal fossa, and in or around the oral cavity, pharynx, larynx, and parotid gland. Clinically, they can be confused with other benign lesions; however, CT allows a specific diagnosis to be made in virtually all cases. This article reviews the CT appearance and differential diagnoses of lipomas in these rare locations and discusses the rare infiltrating lipoma and the relationship between parotid lipomatosis and sialosis.